Prostate Cancer: Treatment Options

How is it treated?

Treatment for Prostate Cancer (like all cancers) varies with the stage of development that the disease is in. Treatment options normally consist of surgery, radiation therapy, or hormone therapy. In some cases, Prostate Cancer is not actively treated because of the overall health or age of the patient. If the tumor is not aggressive (fast growing), then treatment is not always beneficial to patients with diminished health. Treatment options are different for each individual case, but there are several common procedures listed below. The information presented is intended to provide patients with information that they can use in discussing treatment options with their physician.

Surgery for Prostate Cancer

Surgery is often followed by radiation to destroy cancer cells that may have spread or may have been missed during surgery.

• Radical Prostatectomy: This surgery involves the removal of the entire prostate gland and some surrounding lymph nodes. It can be performed by way of an incision in the abdomen (retropubic prostatectomy) or by an incision in the skin between the scrotum and anus (perineal prostatectomy). Lymph nodes cannot be removed during a perineal prostatectomy so an additional procedure accompanies it. A very small incision can be made in the abdomen and lymph nodes are removed using a thin, lighted tube (laparoscope). Radical Prostatectomy normally involves a hospital stay of about three days and a 3 to 5 week absence from work.
  
  
• Cryosurgery: This surgery is normally used as an option for men who cannot have traditional surgery or radiation treatment. A small, metal instrument is placed into the tumor by way of an incision between the scrotum and anus. The metal instrument is used to freeze and kill tumor cells. The patient is awake during the procedure and an epidural or spinal anesthesia is used. A 1 to 2 day hospital stay is typical.
  
  
• Transurethral resection of the prostate (TURP): This surgery is normally used to relieve symptoms of men who cannot have a radical prostatectomy. It does not cure the cancer and is normally followed by an alternate, non-surgical treatment. TURP is performed without an incision in the skin. A thin tube is placed through the urethra and into the prostate. The thin wire on the end of the tube is used to cut away cancerous tissue. The procedure normally only takes about an hour and involves a 1 to 2 day hospital stay.
  

Other Treatments

• Radiation Therapy - This treatment is typically used in patients with early stage Prostate Cancer or as follow up for patients that have already had surgical treatment. In some cases X-rays can be used to kill or shrink cancer cells at the site of the tumor. The radiation may be administered by a machine, such as a linear accelerator or cobalt apparatus, or from a radioactive source implanted within the diseased area. External radiation from a machine is normally given in an outpatient facility 5 days a week for 6 weeks. Internal radiation from an implant sometimes involves a short hospital stay for the procedure. The implant may be temporary or permanent. External beam radiation is focused from a source outside the body on the area affected by the cancer and is, therefore, not the primary treatment for cancer that may have spread.
  
  
• Hormone Therapy - Hormone therapy includes all treatments that control tumor growth by means of hormone regulation. Prostate cell growth is dependent on certain hormones, primarily testosterone. Restriction of these hormones can limit the growth of cancerous prostate cells, including those that have spread to other areas of the body. Hormone therapy may be used to control the growth of cancerous prostate cells for a long period of time, but eventually the cells may begin to grow again despite the absence of male hormones. There are several ways to regulate these hormones:
  
  
  • Orchiectomy - This procedure involves the surgical removal of the testicles, which are the main source of male hormones. A drug, antiandrogen, may follow the surgery to block the effects of any remaining male hormones.
    
    
  • Luteinizing Hormone-Releasing Hormone (LHRH) Agonist - This method prevents the release of testosterone from the testicles. A drug, antiandrogen, may follow the treatment to block the effects of any remaining male hormones.
    
    
• Clinical Trials - There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects.

Possible Side Effects from Surgical Treatment

• Radical Prostatectomy - As a result of surgery, there may be damage to the nerves that control erections and bladder muscles. Impotence and incontinence are always a possibility after prostate surgery. These effects can be temporary, but for some men they are permanent. Retropubic prostatectomy has a lower incidence of nerve damage. New nerve sparing techniques can be used to lower the risk of impotence and incontinence, but the risk is not eliminated.
  
  
• TURP - There may be some minor bleeding in the urine immediately after the operation. Some patients may also experience temporary problems with bladder control.
  
  
• Cryosurgery - The freezing process may damage nearby nerves resulting in impotence or incontinence. If the bladder or intestines are damaged during the procedure, then patients may experience pain, a burning sensation, and a need to empty the bladder and bowels often.
  

Possible Side Effects from Non-Surgical Treatments

*Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy
  
  • Nausea, vomiting, diarrhea
    
  • Frequent urination, blood in urine, and burning sensation while urinating
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
  • Fatigue
    
• Hormone Therapy
  
  • Loss off sexual desire, impotence
    
  • Hot flashes
    
  • Breast tenderness
    

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